Surgical outcome of brain contusions treated by decompressive craniotomy with or without lobectomy at high volume tertiary care trauma centre

Abstract

Aims and objective

To assess and compare surgical outcome of brain contusions treated by Decompressive craniotomy with or without lobectomy or contusectomy.

Methods

156 patients of severe TBI, operated for brain contusions from January 2009 through December 2010 were reviewed. The patients with brain contusions >20 cm³ in volume were included in study. In group A, decompressive craniotomy with lax duraplasty was done; in group B decompressive craniotomy with lax duraplasty along with excision of brain contusion or lobectomy was performed.

Results

There were 101 patients in group A and 55 in group B. Both groups were compared for demographic data, CT findings, GCS, time from injury to surgery, duration of surgery, blood loss, hospital stay, mortality and Glasgow outcome scale. Contusions were larger in group B (p = 0.0001). Pupillary reaction was worse in group B (p = 0.037). The time from injury to presentation to casualty (p = 0.0033) and time from injury to surgery (p = 0.0008) was longer in group B. Blood loss (p = 0.0001) and duration of surgery (p = 0.0013) were higher in group B. Rest other parameters were not significantly different. In group A, mortality rate was 63% and 50% in group B (p = 0.131). 28% patients in group A and 42% in group B had good outcome (p = 0.073).

Conclusions

Adequate contusectomy or lobectomy is useful in severe TBI with contusions. The results of present series suggest that one should be very aggressive in managing brain contusions to achieve better outcomes.

Keywords

Brain contusion - Decompressive craniotomy - Lobectomy - Outcome

Abbreviations

CT, Computer tomography - GCS, Glasgow Coma Scale - NSRL, Normal Size Reacting to Light - NRL, Non-Reacting to light

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